Where candidates for Michigan governor stand on mental health privatization

Health Care

Michigan government has been studying ways to improve the split mental and physical health systems since 2016

Next governor and state Legislature will have big say in future direction

The six candidates for governor who will share a debate stage on May 31 at the Detroit Regional Chamber's Mackinac Policy Conference. From top left to right, the Democratic field: Ann Arbor businessman Shri Thanedar, former state Sen. Gretchen Whitmer of East Lansing and former Detroit health department director Abdul El-Sayed of Shelby Township. From bottom left to right, the Republican field: Attorney General Bill Schuette of Midland, Lt. Gov. Brian Calley of Portland and state Sen. Patrick Colbeck of Canton Township.

The next governor could either continue with the ongoing plan to privatize the Medicaid behavioral health system or stop what is called Section 298 in its tracks.

It is quite possible the next governor of Michigan could be the one to either continue with the ongoing plan to privatize the Medicaid behavioral health system or stop what is called Section 298 it in its tracks.

He or she also could instead choose to work with state legislators to improve the current Medicaid mental health system, a $2.6 billion system that many families and consumers feel has let them down.

What do I mean? Let me explain.

In early 2016, Gov. Rick Snyder approved a plan to allow the Medicaid health plans to manage all behavioral health services in an integrated way. Essentially, Section 298 in his proposed fiscal 2017 budget would have combined the $9 billion physical health system, managed by private HMOs, with the quasi-government behavioral health system, managed by 10 regional entities called prepaid inpatient health plans.

But the people forced the Snyder administration to put the brakes on that effort in mid-2016. The state Department of Health and Human Services was instructed to oversee stakeholder workgroups that issued various recommendations on how to improve the system.

However, the state Legislature in 2017 chose to ignore most of the recommendations and approved four regional pilot programs to test some of the integration concepts. Originally, the pilot programs, one in Genesee County, would have begun this October. Now they have been delayed until October 2019.

It isn't clear why the pilots were delayed. Sources gave several reasons, including giving time for a new administration and Legislature to reconsider, but also because the pilots had become so complex and potentially unworkable that the proposed plan was falling apart under its own weight.

The new start date for the pilots, October 2019, happens to be during the first year of the new governor's term, meaning a new administration could either keep things going, speed them up, alter them or change directions completely with the help of a freshly seated new state Legislature.

Crain's asked each of the major candidates for governor where they stand on the complex questions of privatization, integration, care coordination and improving behavioral health services under Medicaid. Each candidate was asked three straightforward questions in an email this week and followed up, in some cases, with short interviews.

The three questions we posed were:

What is your position on Section 298?

Do you support privatization and giving the $2.8 billion in Medicaid funds to health plans to manage care coordination and integration with behavioral health provider system?

"Every Michigander deserves quality, affordable health care," Whitmer said in a statement. "Integrating services is one way we can lower costs and improve the quality of care, but there has to be accountability. If we move forward with integration, we've got to make sure our system isn't taken over by one managed care firm."

Shri Thanedar: Opposes privatization because he believes it does not lead to improved services and reduced costs. He would improve the current behavioral health system by requiring providers and agencies to adopt best practices and work more closely with doctors, hospitals and health plans.

"Republicans always maintain that privatization lowers costs. I have seen no evidence of that. I've seen profiting by private corporations at the expense of average Michiganders who always see a decrease in services," he said. "Mental health is an issue very close to me. I lost a wife who suffered from mental illness. I raised my two boys, 4 and 8, until I got remarried."

Thanedar said he would continue to have state government manage the behavioral health system, but bring up the efficiency and expertise level to improve integration and deliver more services.

Patrick Colbeck: Supports a free-market based mixed managed care model that integrates behavioral health with physical health. He neither wants to turn over 100 percent funding to health plans to manage the nearly $13 billion Medicaid behavioral and physical health systems, nor does he want to keep the status quo.

"I am OK with privatization and public (management) of behavioral health. (Healthy Michigan Medicaid) expansion destroyed our mental health system in Michigan," Colbeck said. "Access to health centers have become more difficult."

Colbeck said he favors allowing health plans to manage Medicaid behavioral health services where it makes sense in certain markets. He also favors allowing high-functioning regional prepaid inpatient health plans to continue to manage Medicaid behavioral health dollars where it works effectively.

"My priority is not whether it is private or public, it is whether it serves the citizens," he said.

Bill Schuette: No specific position taken on Section 298 and privatization, but he believes that mental health must be a priority and that Michigan's mental health care system should be improved. The improvement must be based on the principles of increased access to care, affordability, innovation and reduced costs and efficiency.

"Bill believes there must be a top-to-bottom review of the mental health system, including Section 298 and everything else," according to a statement from Schuette's campaign. "He will make judgments at that time on what reforms are proper, necessary, innovative, and provide the best care options."

Brian Calley:Calley has said in the past that he supports the Section 298 process, one that he helped guide during 2016 after Snyder's boilerplate was made public. He also has said he would like to see a full testing of various ways to integrate physical and behavioral health services.

However, Calley said in an email Saturday morning: "Separate is not equal. We need a mental health system that integrates brain care and behavioral healthcare with the rest of the body and improves the health outcomes for people with mental illnesses.

"I do not carry preconceived notions or philosophical positions about the best way to administrate integrated care. Exploring options with willing partners in pilots is a prudent way to proceed before making systemwide changes."